Pre-fabricated Anterior Guidance Package Kit for patients having bruxism/clenching habit with or without various malocclusions-II

ABSTRACT

A pre-fabricated, pre-programmed or custom-made guidance package is provided. The Anterior Guidance Package (AGP) of current invention is comprised of one maxillary guidance component and one mandibular guidance component produced in many shapes and sizes. Those components are attached to a maxillary retention piece and a mandibular retention piece, respectively when the mandible is at a point defined by an operator to provide ideal anterior guidance for the mandible, or to provide specialized guidance for a damaged stomatognathic system. In contrast to all current bruxism or Tempor-mandibular disorders (TMD) appliances, the AGP according to current invention provides a wide range of features and options including three-dimensional control, superior mechanical advantage and preferable vertical dimension at rest. The primary purpose is to provide a superior anterior guidance night guard including relief of centric occlusion/centric relation discrepancy for the amelioration of the damage and pain caused by bruxism.

Current application is Continue-in Part of U.S. patent application Ser.No. 13/573,283, which was filed on Sep. 6, 2012.

FIELD OF THE INVENTION

Current application relates to an anterior guidance package, especiallyan anterior guidance package pre-fabricated in various sizes and shapesto be used to produce a superior night guard for the amelioration of thedamage and pain caused by bruxism, or the treatment of other variousmaladies of the stomatognathic system to include the mouth, jaw, musclesor other tissues of mastication, or the TMJ.

BACKGROUND OF THE INVENTION

Bruxism is an inappropriate activity that causes many dental and medicalproblems. Dental conditions to include malocclusion and centricrelation/centric occlusion discrepancy can amplify the damage caused bybruxism. Some of the problems include myo-facial pain syndrome, damageto teeth, and damage to the temporo-mandibular joints (TMJ). Many kindsof ‘night guards’ have been developed to ameliorate the negative impactsof bruxism. These include appliances that provide simple coverage ofteeth, and also appliances that correct the centric relation/centricocclusion discrepancy which allow the TMJ to relax in its mostanatomically appropriate and best stress bearing position (centricrelation), and also appliances that provide anterior guidance, whichamong other benefits reduces significantly the inappropriate muscleforce associated with bruxism. The best night guards are those thatcombine all three of these features. Simple coverage of teeth does helpreduce damage to teeth by providing a barrier. However, without centricocclusion/centric relation (CO/CR) discrepancy correction and withoutanterior guidance, this type of night guard could actually causeincreased severity of bruxism. As a result, causes worse myo-facial painsyndrome and a greater tendency toward TMJ damage. The correction of acentric occlusion/centric relation (CO/CR) discrepancy eliminatesdeviating tooth contacts in the posterior occlusion allowing thecondyles to seat into their most comfortable positions. By eliminatingthe contact of deviating inclines of teeth in a malocclusion there willbe no proprioceptive message to muscles to deviate around thatinterference. When the muscle stops being stimulated into holding themandible in a deviated position, then normal muscle activity can resumeand spasticity will cease. Anterior guidance refers to a particularfunction of anterior teeth to provide physical limits of movement of thefront end of the mandible. Appropriate anterior guidance in centricrelation position, long centric, straight protrusive and lateralexcursions protects back teeth and reduces the muscle forces of bruxismbecause of the mechanical advantageous position of being anterior to themuscle power used to close the mandible. Traditionally, dentists havebeen able to improve CO/CR discrepancies and anterior guidance bycreating a custom made and custom adjusted night guard, which typicallyare attached to the maxillary or mandibular teeth and opposed by naturalteeth. This appliance is custom built for a patient by a dentistconsidering their particular malocclusion and other factors allowing themandible to be in centric relation with appropriate anterior guidancegiving the patient significant relief from the damage and pain ofbruxism. However, a dentist must spend a lot of time and effort tocustom create and custom modify a night guard to try to achieveappropriate anterior guidance and reduce CO/CR discrepancy for apatient's particular malocclusion. These efforts are further complicatedby missing teeth, or periodontally weakened teeth. The patient must alsospend a lot of time to achieve the desired result and a high cost. It isthe purpose of the current invention to provide a means to allow adentist or even a non-dentist to create a superior night guard that iseasier and faster to make and more affordable for the patient. It isanother purpose of the current invention to remove the variable factorsof maloccluded teeth, missing or periodontally weakened teeth. The thirdpurpose of the current invention is to provide superior anteriorguidance and simultaneously obliterate any CO/CR discrepancy by anindividual who does not even necessarily posses the specializedknowledge of a dentist. A less common application of the currentinvention is to provide a treatment platform for other maladies ofmouth, jaw, muscles or other tissues of mastication, or the TMJ(temporomandibular joint). The three-dimensional guidance and limits forthe mandible available with the current invention allow a cliniciantreatment strategies heretofore not available.

DESCRIPTION OF PRIOR ARTS

U.S. Patent Application Publication 20100279246, 20070178420,20070099144 by Keski-Nisula; Katri; et al. discloses an odontologicaldevice and device series to guide an individual's occlusion and a methodto be used in selecting an occlusion guidance appliance device to beused in orthodontic treatment. This kind of device contains a U-shapedarch with a lower surface on the side of the lower jaw and a highersurface on the side of the upper jaw, and in both of which there areconcaves in which to place the individual's teeth, and where the bottomsof the concaves form of the isthmus separating the concaves from oneanother.

United States Patent Application publication 20130146067 to Tschackertillustrates a dental splint with a U-shaped base and wall-shapedreinforcements on the tongue and lip sides, said reinforcements formingchannels, and to a method for the production of said dental splint. Thedental splint for the upper jaw can be designed such that a free spaceis formed in the front teeth region after inserting the dental splintand clenching the teeth, whereby additional air for breathing can reachthe oral cavity.

United States Patent Application Publication 20130098375 to Urbanekillustrates a device for mitigation of temporomandibular joint disorderwith lingual tooth surface contact surface, hard palate conformity,anterior pad, and pad wings. The device is conformed in essentially aU-shape, or arch, having an anterior middle portion. Extendingposteriorly from opposite sides of the anterior middle portion are padwings. The whole device is contoured to communicate with an upper jawand detention thereof. The device comprises a top surface and a bottomsurface.

United States Patent Application Publication 20120272972, 20120266897,20120266896, 20110139162 and 20100147315 to CHODOROW illustrates aone-piece molded bruxism treatment device which in upright orientationhas top and bottom parts, including: an elongated band having agenerally U-shape defining a closed front end part and legs extendingrearward and adapted to be positioned around the outer surfaces of aperson's upper gums and teeth, and two generally planar resilientlydeformable bite pads oriented generally horizontally, each extendingfrom one of the feet of the band medially toward the other.

United States Patent Application Publication 20110308532 to Nelissenillustrates an apparatus which can be placed clampingly on a lower jawor upper jaw, in particular on the molars and/or pre-molars thereof,essentially consisting of:—at least a left and a right buccal shapedbody on the buccal side;—one or more connecting elements between theleft and right buccal shaped body, wherein the left and right buccalshaped bodies extend at least along respectively the left and rightmolars and/or premolars and/or canines; and wherein the one or moreconnecting elements are adapted to push the left and right shaped bodiesinto the undercuts of the molars and/or premolars and/or canines.

United States Patent Application 20110114100 to Alvarez et al.illustrates a dental mouthpiece clenched between the teeth and used toalleviate numerous dental and medical conditions as well as increase auser's performance. The mouthpiece improves facial tone and providesrelief of temporomandibular joint pain and associated grinding of theteeth. The mouthpiece is less visible than prior art devices, even whenthe wearer opens his/her mouth, and does not cause discomfort.Furthermore, the mouthpiece allows for substantially unaffected speech,by the strategic placement of protuberances, so that the user may keepthe mouthpiece in place and proceed about his or her business withoutproviding any sound or visual cues to the presence of the mouthpiece.

United States Patent Application 20110030704 to Hanna illustrates acomfortable multiple layer mouth protector is provided for strength andease of fit to minimize if not completely and gradually eliminatebruxism, with spring biasing keeping the maxillary and mandibular mouthprotector arches in place and apart, eliminating snoring and permittingeasy breathing. In addition, this Mouth protector protects oralstructures from sports injuries.

United States Patent Application 20080099029 and 20070079833 to Lamberg;Steven B. illustrates an intraoral mandibular advancement device totreat sleep disorders in a user having an obstructed airway includes amaxillary appliance with a main body for removable attachment to themaxillary teeth; a protrusive element distending from the centralportion of the main body; and retention means extending from the mainbody for retention of the device on the maxillary teeth during sleep. Amandibular appliance removably attaches to the mandibular anterior teethand includes a lingual spacer that extends posteriorly from themandibular anterior teeth. The anterior aspect of the protrusive elementof the maxillary appliance contacts the posterior edge of the lingualspace and thereby causes mandibular advancement.

U.S. Patent Application Publication 20080000483, U.S. Pat. Nos.6,161,542, 6,041,784, and 5,365,945 to Halstrom disclosed an intra-oraldental appliance for treatment of sleep disorders including snoring,sleep apnea and nocturnal bruxism. The appliance includes an uppermember conforming to the patient's maxillary dentition; a lower memberconforming to the patient's mandibular dentition; and a connectingassembly for adjustably coupling the upper and lower members together.The only benefit in regard to bruxism is that Halstrom's appliance doesseparate teeth therefore damage to teeth would be eliminated. However,his connecting assembly places the jaw in an unnatural position. Thismay cause many problems because the major goal of treatment for toothdamage, myofacial pain, migraines etc secondary to bruxism, is to allowthe jaw (mandible) freedom to relax to its most comfortable position.This position would be centric relation for 99% of people. Centricrelation allows the jaw to be in its most anatomically correct stressbearing position and the place where the muscles are most calm. Dentistsuse centric relation or this even more refined point to create a nightguard that allows the mandible to rest there and then guidance from thatposition to avoid posterior interferences and freedom so the jaw canmove, the patient can yawn, open, sneeze, breathe, swallow etc.normally.

When a person, having malocclusion, closes their mouth, the jaw isforced to adapt a position other than centric relation. Because ofmuscle engrams the jaw ends up living in this inappropriate position. Bylocking the lower jaw forward in relation to the upper jaw over time,this will happen when a person wears Halstrom's appliance, the personmay experience unintended and inappropriate orthodontic movement of theteeth that create or make worse the malocclusion. By locking the lowerjaw forward in relation to the upper jaw you have pulled the mandibularcondyle down the articular imminence to a very inappropriate position(not in the fossa). It may prevent damage to teeth but if the personexerts muscle activity in that position one is more likely to damage theTMJ. One major purpose of a night guard is to allow the persons jaw toassume the position of centric relation, not purposely pull the jaw intosome other position.

Myofacial pain would be terrible for a person wearing this typeappliance since the condyles and muscles of mastication are artificiallypulled into very inappropriate positions.

U.S. Patent Application Publication 20050288624, U.S. Pat. Nos.7,654,267, 5,795,150 (which is assigned to NTU-tts, Inc.), and U.S. Pat.No. 5,085,584 by Boyd, and U.S. Pat. No. 6,666,212 to Boyd. Sr.,illustrate an intraoral discluder for preventing chronic tensionheadaches, common migraine headaches, and temporo-mandibular disordersthat are caused or perpetuated by chronic activity of the temporalismuscle. The discluder includes a trough, contoured to encompass at leastone maxillary or mandibular incisor, from which extends a protrudingplatform, for engagement by the opposing incisors. The trough can beretained on the teeth by any adaptable material than can flow around theteeth and then maintain its shape. Once in place in the wearer's mouth,one or two opposing incisors will come into contact with the platformprior to the upper and lower posterior and/or canine teeth coming intocontact, regardless of the position of the mandible, thereby reducingthe intensity of the activity of the temporalis muscle. In addition, aspecial post on the discluder's platform is engageable directly with oneor more opposing incisors, to act as a stop and thereby inhibitexcessive retrusive movement of the mandible and urge the mandibletoward a more protrusive position. This can reduce the intensity ofundesired clenching, and it can enhance the size of the wearer'spharyngeal airspace, thereby reducing the incidence and severity ofsnoring.

However, Boyd's invention did not consider patients who havemalocclusion, loss of teeth and weak teeth, etc. If a patient with suchabnormalities on teeth wears Boyd's intraoral discluder and brux whilesleep and functions against these teeth, it could make the patient'stooth problems worse. Also, many people have reported chipping teeth,which oppose this appliance. Also, because the guidance is flat thereare many malocclusions that to disclude the mandible enough to avoid theposterior interferences the vertical dimension of the appliance couldbecome so big as to make the appliance uncomfortable or impossible towear. This appliance therefore cannot intervene as effectively to asmany types and severities of malocclusions as the current invention.

On the web site of http://www.ChairsideSplint.com NTI-tts, Inc.commercially broadcast a new intraoral discluder for preventing chronictension headaches, common migraine headaches, and temporo-mandibulardisorders that are caused or perpetuated by chronic activity of thetemporalis muscle. That product is shown in the U.S. Pat. No. 6,666,212to Boyd Sr. But, NTI-tts modified the Boyd's invention slightly bydeveloping a three dimensional guidance on the surface of the surface ofthe through (18) by trial and error of a dentist. They said it usuallytake couple of hours to finish that “opposing slider.” In their video, adentist engages a preliminary “opposing slider” on the mandibularincisors of a patient and asks the patient whether the “pain” is gone orbetter. If the patient say ‘no’, the dentist takes it out of thepatient's mandibular incisors and cuts the surface of the trough (18)again and again until the patient says its ‘better.’ So trail and errorcustomization by a dentist is still necessary, and is not so differentfrom the traditional method of carving anterior guidance under the lowersurface of maxillary retention piece of a traditional splint. The onlydifference is that the “opposing slider” is smaller and cheaper. It doesnot eliminate the trial and error method performed by a dentist. Thematerial may be cheaper than the traditional splint, but there is stilla specific labor cost of the dentist that must be done. And the patientmust wait until the dentist carves a right shape for the patient. Also,because the anterior guidance that is created is flat therefore thevertical dimension of the entire appliance will be larger even when thepatients' mandible is at rest, not necessarily just in an excursion.This increase in vertical dimension could be so excessive as to precludemany patients from being able to utilize NTI-tss.

U.S. Pat. No. 4,773,854 to Weber disclosed herein is a device for therepresentation of condylar movements of a patient and their correctsimulation which includes models of sets of teeth to determine therequired corrections to the biting surfaces in order to obtain idealocclusion. The device includes an articulator with the lower partthereof able to be brought into a predetermined three-dimensionalrelation with respect to an upper part of the articulator and having twoblocks having guide elements on the lower part of the articulator tosupport condyle balls of the upper part of the articulator. The devicefurther includes a lower jaw recording bow and an upper jaw recordingbow which can be brought into an active and predetermined relation withrespect to the articulator and which disposes of at least threerecording plates with corresponding recording pins as well aspositioning spoons for the combination of a lower jaw dentition model.With this device, opening movements of articulation may be recordedthree-dimensionally so that three clear crossing points are created forthe occlusion.

U.S. Pat. No. 4,901,737 to Toone discloses an intra-oral appliance forreducing snoring which repositions the mandible in an inferior (open)and anterior (protrusive) position as compared to the normally closedposition of the jaw. Once the dentist or physician determines theoperative “snore reduction position” for a particular patient, anappropriate mold is taken of the maxillary dentition and of themandibular dentition for formation of the appliance template. The Tooneappliance includes a pair of V-shaped spacer members formed from dentalacrylic, which extend between the maxillary and mandibular dentition toform a unitary mouthpiece. In an alternative embodiment of the Tooneinvention, the spacer members are formed in two pieces and a threadedrod is provided to enable adjustment of the degree of mandibularprotrusion or retrusion after the mouthpiece is formed.

European patent application No. 0,312,368 published also discloses anintra-oral device for preventing snoring. This device consists of aU-shaped mouthpiece, which conforms to the upper dental arch of the userand includes a sloped, lower ramp for engaging the mandibular dentition.Normal mouth motions, such as the clenching of the jaw, will cause someof the mandibular dentition to engage the underside of the ramp, therebycamming the lower jaw forward to increase the spacing between the baseof the tongue and the posterior wall of the pharynx.

U.S. Pat. No. 5,722,828 to Halstrom discloses an apparatus and methodfor producing a gothic arch tracing representative of the natural rangeof motion of a patient's mandible. The apparatus consists of a kitincluding a mandibular bite rim having a tracing plate; a maxillary biterim having a tracing arm; and a stylus releasably connectable to thetracing arm for extending between the tracing arm and the tracing plateexternally of the patient's mouth. The stylus has a marker on one endthereof for drawing a gothic arch tracing on a removable papersubstrate, such as a post-it note, attachable to the tracing plate. Thetracing is used in the fabrication of a dental bite registration moldfor the patient. The mold may in turn be used to mount casts of thepatient's dentition in a specific relationship as required forprosthetic or therapeutic purposes.

Frank et al, disclosed a full contact splint with anterior guidance onthe internet at addresshttp://www.greatlakesortho.com/content/files/resources/SplintApplianceSelectionGuide_S222.pdf.The full contact splint with anterior guidance is to form an anteriorguidance under the lower surface of the maxillary retentive piece.However, developing anterior guidance directly to the lower surface ofthe maxillary retentive piece is very time consuming trial and error joband expensive for both of dentist and patient.

From the above prior arts it is found that none of the prior artprovides the ability to treat bruxism, and TMD to include a broad rangeof malocclusions as economical, as easy to apply, and medically safe asthe anterior guidance package (AGP) as provided in the currentapplication.

SUMMARY OF THE INVENTION

Many people who inappropriately brux or clench also have thecomplicating factors of a mal-occlusion that cause discrepancy betweencentric occlusion and centric relation. Another factor that can amplifythe pain and damage potential of bruxing/clenching is inadequateanterior guidance. Bruxism and bruxism combined with these factors cancause myofacial pain syndrome and many other types of damage to theteeth, muscles, TMJ (Temporo-mandibular Joint) and other tissues. Manykinds of ‘Night Guards’ have been provided to allow the mandibularcondyles to locate in their most comfortable position by freeing themandible from malocclusions and posterior interferences. Anteriorguidance is a physical limitation of all excursions of the jaw.Elimination of centric relation/centric occlusion discrepancies allowsthe patient to be free of their malocclusion to allow the patients' jawto acquire centric relation position. Anterior guidance and freedom ofthe jaw from centric relation/centric occlusion discrepancies can beprovided in a custom fabricated and custom adjusted acrylic night guardmade by a dentist on the occlusal/incisal surface of the maxillary teethor mandibular teeth. However, a dentist must spend a great deal of timeand effort to create and modify a customized night guard for the patientto create anterior guidance and relief from centric occlusion/centricrelation discrepancy in consideration of their particular malocclusion.It also burdens the patient with time and cost. It is the purpose of thecurrent invention to provide an anterior guidance package for a splint,superior anterior guidance installed night guard, which is moreaffordable for patients and easier to create for dentists, even for anon-dentist. Another purpose of the current invention is to provide ananterior guidance package for an easy to make anterior guidanceinstalled night guard for patients of various malocclusions. Anotherpurpose of the current invention is to provide three dimensional controland limits to the front end of the mandible to provide treatments forother maladies to include meniscus displacement, clinical closed lock ofthe TMJ, and various other disorders of the jaw, teeth, muscles andother tissues of mastication and mouth. A pre-fabricated, pre-programmedor custom-made guidance assembly Anterior Guidance Package (AGP) isprovided. The anterior guidance package of current invention iscomprised of one maxillary guidance component and one mandibularguidance component. Those guidance components are attached to amaxillary retention piece and a mandibular retention piece of a splint,respectively, to provide superior anterior guidance to the mandible. AnAGP splint kit according to current application can provide a fast,inexpensive, easy way to construct a high quality anterior guidanceequipped night guard (orthotic appliance) that will be superior to acustom appliance constructed by a dentist. The AGP of current inventionis produced in many different shapes and sizes and can be indexed incentric relation or some other position based on the patients'diagnosis, and therapy or treatment being provided to the patient.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is an exploded view of the Anterior Guidance Package (AGP)according to current invention connected to a mandibular retention pieceand a maxillary retention piece of a splint.

FIG. 2 is a cross-sectional side view of the Anterior Guidance Package(AGP) assembled in its correct orientation by a removable holder beforeit is indexed onto the maxillary and mandibular retentive pieces.

FIG. 3 is a perspective cross-sectional view of the mandible hinging upin centric relation finding the first contact on teeth or retentivepieces and placing a spacer at that location.

FIG. 4 is a perspective cross-sectional view of the mandible hinging upin centric relation indexing the Anterior Guidance Package (AGP) ontothe retentive pieces when the mandible is in centric relation and thevertical dimension is appropriate according to the first contact.

FIG. 5 is a plane view of the maxillary guidance component of the AGP ofcurrent invention.

FIG. 6 is a view of the internal topography of the maxillary guidancecomponent of the AGP showing the specific guidance of a centric relationstop, long centric area, lateral excursion guidance, and protrusiveguidance.

FIG. 7 is a superior transparent view of the AGP of current inventioncorrelating the centric relation position of the TMJs coincident withthe indexing of the AGP, and the available guidance to the mandibularguidance component from the maxillary guidance component from theposition of centric relation.

FIG. 8 is a frontal view of AGP of current invention solidly adhered onretentive pieces by adhering filler and worn by a patient.

FIG. 9 is an enlarged cross sectional view of the maxillary guidancecomponent of the AGP according to current invention along the line A-A′.

FIG. 10 is an enlarged, cross sectional view of the maxillary guidancecomponent of the AGP according to current invention along the line B-B′.

FIG. 11 is a perspective view of the mandibular guidance component ofthe AGP of current invention.

FIG. 12 is an enlarged, cross-sectional side view of movement of themandible of a patient wearing the AGP equipped night guard.

FIG. 13 is a more enlarged schematic drawing that shows how theappropriate protrusive guidance provided by the AGP of the currentapplication eliminates posterior interferences when a patient is bruxingprotrusively.

FIG. 14 is an enlarged, cross-sectional front view of movement of themandible of a patient wearing the AGP equipped night guard

FIG. 15 is a more enlarged schematic drawing that shows the appropriatelateral guidance provided by the AGP of the current application thateliminates posterior interferences when the patient is bruxing in a leftor right lateral excursion.

FIG. 16 is a schematic combined view of an alternative design of the AGPfor bruxism, a “canine guidance anterior guidance” AGP.

FIG. 16-a is a perspective cross-sectional view of the mandible hingingup in centric relation indexing a bruxism AGP for a patient with orwithout a complex malocclusion onto the special retentive pieces whenthe mandible is in centric relation and the vertical dimension isappropriate according to the first contact.

FIG. 16-b is perspective view of the special retention piece and theheight adjustable shelf for a bruxism AGP for a patient with or withouta complex malocclusion.

FIG. 17 is a schematic combined view of an alternative design of the AGPfor bruxism, a “group function anterior guidance” AGP.

FIG. 18 is a schematic combined view of an alternative design of an AGPto treat TMD, an “asymmetric TMD treatment” AGP.

FIG. 19 is a schematic combined view of an alternative design of an AGPto treat TMD, an “a bilateral anterior repositioning TMD treatment” AGP.

FIG. 20 is a schematic combined view of an alternative design of an AGPto treat TMD, an “a unilateral anterior repositioning TMD treatment”AGP.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

A splint called a ‘night guard’ is a hard material built on eithermaxillary and/or mandibular teeth. It is custom fabricated and customadjusted by a dentist to provide anterior guidance and eliminateposterior interferences. The splint allows the patient to be free oftheir malocclusion and allows the patient to acquire centric relationposition. Usually a dentist customizes a splint for a particularpatients' malocclusion, typically an acrylic splint on one arch opposingnatural teeth.

These are expensive appliances because a dentist must spend the timecustom creating and custom modifying the night guard to provide anteriorguidance and eliminate posterior interferences for the patient inconsideration of their particular malocclusion. The patient does stillinappropriately clench/brux, albeit with much less force, overall painand damage. So, the applicant developed an Anterior Guidance Package(AGP) that makes a night guard easier to construct, more affordable fora patient and saves dentist's time.

FIG. 1 is an exploded view of the Anterior Guidance Package (AGP) (1),according to current invention connected to a mandibular retention piece(2) and a maxillary retention piece (3) of a splint (4) by adhesivefiller (1-c).

The Anterior Guidance Package (1) of current invention is apre-fabricated, pre-programmed or custom-made guidance assembly. TheAnterior Guidance Package (1) of current invention is comprised of onemaxillary guidance component (1-a) and one mandibular guidance component(1-b). Those guidance components (1-a), (1-b) are attached to themaxillary retention piece (3) and the mandibular retention piece (2) ofa splint (4), respectively, by proper means of attachment to providesuperior anterior guidance to the mandible. The proper means ofattachment includes, but not limited to adhesive filler glue, screws andpins, etc. These designs can be standardized or individualized based onmany variables and goals but generally will provide to a patient idealanterior guidance and the elimination of centric occlusion/centricrelation discrepancies. The anterior guidance package (AGP) (1) could beany of many designs. In contrast to a splint that is customized againstthe dentition of the opposing dental arch or even one splint opposinganother splint, the components of the Anterior Guidance Package AGP (1)according to current invention can provide a wide range of features forbroad application including the replication of ideal anterior guidanceof teeth as would be found in an ideal occlusion. The AGP (1) accordingto current invention can be of any three dimensional patterning,steepness of inclination and many other design considerations dependentupon the purpose.

1. Traditional Procedure of Providing Anterior Guidance to a Patient

In order to apply an anterior guidance equipped splint to a patient in atraditional procedure the dentist would:

Create an acrylic splint on the teeth of either the maxillary or themandibular arch.Using articulation paper to mark the contacts of the opposing teeth oran opposing splint in centric relation on the acrylic splint, thedentist will carve the acrylic developing both anterior guidance and theelimination of posterior interferences in the acrylic splint. He willpolish the night guard and deliver it to the patient. This proceduremust be done by a dentist who has broad knowledge of how thegnathostomatic system works. These night guards are therefore timeconsuming and expensive for the patient because every time the dentistcreates a night guard he develops by gradual and time consuming carvingthe anterior guidance and the elimination of interferences in centricrelation until it fits the patient.

2. Procedure of Applying Pre-Programmed AGP of Current Invention to aPatient.

From the long period of practicing as a dentist, the inventor found thatmost average adults have anterior guidance that if it were ideal, fitwithin specific relative dimensions and patterning.

FIG. 2 shows a cross-sectional view of the not as yet separated AGP ofcurrent invention before it is indexed onto their respective retentivepieces. The holder (H) keeps the AGP (1) package together in its correctorientation until the components of the AGP are indexed appropriately incentric relation and in vertical dimension.

FIG. 3 shows the maxillary arch with the maxillary retentive piece (3)molded onto the maxillary teeth and the mandibular arch with amandibular retentive piece (2) molded onto mandibular teeth hinging upin centric relation (CR).

First the operator (usually a dentist) identifies what is the firstcontact (FC) in centric relation (CR). When the mandible (13) is hingedup in centric relation, the position of the first contact (FC) of teethor retentive pieces is variable dependent upon the malocclusion of thatparticular patient and is most often an inappropriate posterior contact.

A 1 mm sticky but removable spacer (SP) is placed on that first contact.

Next the mandible (13) is hinged again up in centric relation and theAGP (1) of current invention is indexed in the most anterior area ofboth the maxillary (3) and mandibular (2) retentive pieces respectively.

FIG. 4 shows the AGP (1) of current invention placed on the anteriorinferior surface of the maxillary retentive piece using adhesive filler(1-c). Adhesive filler (1-c) is already placed on the surface of the AGP(1) as shown in FIG. 2. As the jaw is hinged up in centric relation andthe sticky but removable spacer (SP) touches the opposing arch at firstcontact (FC), the adhesive filler (1-c) is displaced from the superiorand inferior surface of the AGP (1) of current invention to define thevertical dimension (VD) for a splint (4-1) that is equipped with the AGP(1) of current invention for that particular patient. Also, themaxillary guidance component (1-a) is indexed onto the maxillaryretentive piece (3) and the mandibular guidance component (1-b) isindexed onto the mandibular retentive piece (2) according to the centricrelation (CR) position of the mandible (13).

The adhesive filler (1-c) left between the retention pieces (2), (3) andguidance components (1-a), (1-b) is hardened and both components (1-a),(1-b) of the AGP (1) of current invention become rigidly affixed totheir respective retentive pieces (2), (3). Then remove the holder (H)from the AGP (1) and the mandibular guidance component (1-b) isseparated from the maxillary guidance component (1-a).

The sticky but removable 1 mm spacer (SP) is removed.

The effect is that the AGP (1) of current invention is now indexedappropriately for whatever occlusion or malocclusion a patient may haveto provide ideal anterior guidance and in the appropriate verticaldimension to eliminate all centric occlusion/centric relationdiscrepancies (or posterior interferences) after the spacer (SP) isremoved in the centric relation position of that particular patient.

FIG. 5 is a plane view of the maxillary guidance component (1-a) of theAGP (1) of the current invention. The plane view of the maxillaryguidance component (1-a) is a square-ovoid shape. The overall shape ofthe maxillary component (1-a) of the AGP (1) is including, but notlimited to, a smoothly rounded square, smoothly rounded oval, smoothlyrounded pentagonal, smoothly rounded hexagonal shape. According todental literature and the inventors experience, it was found that thelong axis (L) of the square-ovoid shape maxillary guidance component(1-a) of the AGP (1) is less than 35 mm, preferably less than 25 mm andthe short axis (S) of the square-ovoid shape maxillary guidancecomponent (1-a) is less than 20 mm, preferably 12 mm. However, the shapeand dimension of the maxillary guidance component (1-a) of the AGP (1)of the current invention is varied depending on the patients' size,dentition, TMJ situation, diagnosis, intent to index in centric relationor some other position, treatment, and the nature of the guidance andlimits intended by the operator.

As shown in FIG. 6, the perspective view of the maxillary guidancecomponent (1-a) of the AGP (1) has a flat area for a stable centricrelation stop (CR) (5) extended into a further area of flat for the longcentric position (LC) (6) of the mandible extending laterally andanteriorly into blended inclines of a concave shape for lateralexcursion guidance (LE) (7) and protrusive excursion guidance (P) (8) toprovide ideal anterior guidance to the patient's mandible by themandibular guidance component (1-b) against these features of themaxillary guidance component (1-a) to minimize muscular force and avoidall posterior interferences. This feature of appropriate anteriorguidance which discludes the mandible downward (inferiorly) in itsexcursions allows for a night guard of significantly less verticaldimension (VD) when the patient is at rest than other designs, much likean ideal occlusion would.

FIG. 7 shows a superior transparent view of the AGP (1) of currentinvention. It shows how the AGP (1) of current invention replicatesideal anterior guidance as defined in current dental literature and theexperience of the inventor. In FIG. 7 point (5) represents where themandibular guidance component (1-b) sits at rest in the maxillaryguidance component (1-a) when the condyle (10) of the temporo-mandibularjoint (TMJ) (11) of the mandible is in its centric relation (CR)position. As a patient functions or bruxes his mandible, the mandibularguidance component (1-b) provides ideal anterior guidance for themandible by means of the mandibular guidance component (1-b) functioningagainst the maxillary guidance component (1-a) in the position ofcentric relation (5), long centric (6), lateral excursions (7), andprotrusive guidance (8). The AGP (1) of current invention provides idealanterior guidance without regard to the position of teeth, the conditionof teeth or missing teeth.

To apply the pre-programmed AGP (1) of the current invention to apatient the following items are needed;

1) One pre-fabricated AGP (FIG. 2 is a cross-sectional side view of thepre-fabricated AGP kit (1) before it is indexed to a patient's retentivepieces). The pre-fabricated AGP (1) kit is assembled and held by aholder (H),2) one mandible retention piece (2), (The mandibular retention piececould be full arch or less coverage but must be highly retentive andstiff. It would be easily moldable to the patients' lower teeth and verythin.),3) one maxillary retention piece (3) (moldable, highly retentive, stiffand thin),4) one 1 mm sticky but removable spacer (SP),5) adhesive filler (1-c), and6) dryer or light curing unit should be prepared.

When those items are ready;

-   (A) Apply to the patient the maxillary retention piece (3) and    mandibular retention piece (2) on his/her teeth.-   (B) Place the patient's mandible into centric relation position and    identify the first contact (FC) (A point that touches first when the    mandible is hinged up in centric relation. This point is highly    variable from person to person dependent upon their malocclusion. It    will be in the posterior segment for most people.)-   (C) Then place a sticky 1 mm but removable spacer (SP) on that first    contact (FC).-   (D) Place the AGP (1) in the anterior inferior aspect of the    maxillary retentive piece (3). The outer surface (superior and    inferior) of the anterior guidance components (1-a), (1-b) is    covered with adhesive filler (1-c).-   (E) Hinge the mandible in centric relation up toward the maxilla and    when the 1 mm sticky spacer touches (SP) the first contact (FC),    index the mandibular guidance component (1-b) onto the mandibular    retentive piece (2). Both components (1-a), (1-b) of the AGP (1)    have now been indexed appropriately to each respective retentive    piece (2),(3) in the correct vertical dimension (VD) by displacing    the adhesive filler (1-c) to that vertical dimension. Also both    components (1-a), (1-b) have been indexed appropriately    anteriorly-posteriorly for that particular patients centric relation    (CR) position. Both components (1-a), (1-b) of the AGP (1) should    now be adhered rigidly with the 1 mm thick sticky spacer (SP) still    on the first contact point.-   (F) Dry or polymerize the adhesive filler (1-c) with a dryer or a    light cure unit to compensate for the gap between the retention    pieces (2), (3) and the anterior guidance components (1-a), (1-b)    and adhere solidly and rigidly.-   (G) Take the entire assembly (4-1) out of the patients' mouth. Then    remove the 1 mm sticky spacer (SP) from the first contact (FC), and    remove the holder (H) from the AGP (1).    -   The AGP (1) equipped night guard (4-1) is now ready for use.

The above described procedure provides a superior night guard to anyprevious method, and is much simpler to construct than any traditionalor previous method of creating a night guard.

In the traditional method, carving anterior guidance and eliminatingposterior interferences on an acrylic platform can take multipleappointments, and takes significant time of a dentist who has extensiveknowledge of the gnathostomatic system.

But, in the new method utilizing the AGP (1), the entire process canhappen in one appointment in significantly less time and could beaccomplished by an individual with significantly less training.

FIG. 8 is a frontal view of the AGP (1) of the current invention solidlyadhered on retention pieces (2), (3) by adhering filler (1-c) and wornby a patient.

Since the role of anterior guidance is to limit and guide the movementof the mandible while a patient is wearing the AGP splint (4-1), athreshold (9) of continuous lateral and protrusive guidance is developedalong the face of the maxillary guidance component (1-a).

FIG. 9 and FIG. 10 are enlarged cross sectional views of the maxillaryguidance component (1-a) of the AGP (1) according to current inventionalong the lines A-A′ and B-B′ in the FIG. 5. The threshold (9) issmoothly extended to the concave internal surface of the maxillaryguidance component (1-a). However, this concave internal surface may bealtered to an asymmetrical concave surface based on the malocclusion orother special considerations of a particular patient. The internalconcave shape can also be of different shapes dependent upon the type ofguidance the operator proscribes and the shape of the mandibularguidance component that will be used (see FIGS. 16-20). The depth (D) ofthe maxillary guidance component (1-a) is, including but not limited to,1 to 5 mm, preferably 4 mm.

FIG. 11 is a perspective view of mandibular guidance component (1-b) ofthe AGP (1) according to current invention. The base (14) of themandibular guidance component (1-b) has the square ovoid shape and samedimension as the maxillary guidance component (1-a) as shown in the FIG.4.

The length of the long axis (L′) of the oval shaped mandibular guidancecomponent (1-b) is, including but not limited to, between 15 to 35 mm.And the length of the short axis (S′) of the oval shaped mandibularguidance component (1-b) is, including but not limited to, between 8 to20 mm.

A smooth rounded protrusion (12) is developed on one surface of thesquare ovoid shaped mandibular guidance component (1-b). Tip of theprotrusion (12) is engaged in the flat to concave inner surface of themaxillary guidance component (1-a) and guides and limits the movement ofa patients' mandible. Height of the smooth protrusion is, including butnot limited to, between 1 to 6 mm, preferably 5 mm. However, the shape,size and dimension of the mandibular guidance component (1-b) of the AGP(1) of the current invention is varied depending on the patients' size,dentition, TMJ situation, diagnosis, treatment, intent to index incentric relation or some other position, and the nature of the guidanceand limits intended by the operator (see FIGS. 16-20).

FIG. 12 is an enlarged, cross-sectional side view of protrusive movementof the mandible (13) of a patient wearing the AGP (1) equipped nightguard (4-1). When a patient, who has a habit of bruxism/clenching, iswearing AGP (1) equipped night guard (4-1) of the current invention, thepatients mandible will experience appropriate protrusive guidance,guiding the jaw inferiorly.

FIG. 13 is a more enlarged schematic drawing that shows how theappropriate protrusive guidance (8) provided by the AGP (1) attached tothe night guard (4-1) to eliminate posterior interferences when apatient is bruxing protrusively. When a patient closes his mandible tofunction or brux, whether in an appropriate occlusion or a malocclusion,the intercuspation of the teeth as they mesh will bring maxillary toothcusp inclines (16) and mandibular tooth cusp inclines (15) into closeproximity or touching (whether they have the thin retentive material onthem or not). In a protrusive excursion of the mandible, without theappropriate anterior protrusive guidance of the AGP (1) of currentapplication, these inclines (15), (16) would collide potentiallydamaging the teeth, but also these deviating inclines (posteriorinterferences) would give a proprioceptive message to the muscles todeviate over these posterior interferences, therefore stimulating themuscles to hold the mandible in this deviated position ultimatelyplacing the TMJ into an inappropriate position and leading to musclespasticity or possible TMJ or other damage. If the guidance were flatlike some previous systems, the vertical dimension of the entireappliance must be increased dramatically to avoid these interferences.Therefore even when the mandible is at rest in centric relation, and noteven in an excursion, the vertical dimension of the entire appliancewould be so excessive, that for many patients, it could not be used orat a minimum be more uncomfortable as compared to the AGP splint (4-1).The AGP (1) of current application solves the vertical dimension problembecause it gives appropriate protrusive anterior guidance (8) also in avertical way using the smooth protrusion (12) of the mandibular guidancecomponent (1-b) guiding the mandible downward (inferiorly) thereforeavoiding collisions of these tooth inclines (15), (16) or the productionof unwanted and inappropriate muscle engrams, much like ideal toothanterior guidance gives to an ideal occlusion.

FIG. 14 is an enlarged, cross-sectional front view of movement of themandible/jaw of a patient wearing the AGP (1) equipped night guard(4-1). When a patient is experiencing bruxism/clenching and wearing theAGP (1) equipped night guard (4-1), his/her jaw/mandible (13) moveslaterally left and right and receives appropriate lateral guidance,guiding the jaw downward (inferiorly).

FIG. 15 shows the appropriate lateral guidance (7) provided by the AGP(1) attached to the night guard (4-1) to eliminate posteriorinterferences when the patient is bruxing in a left or right lateralexcursion. When a patient closes his mandible to function or brux,whether in an appropriate occlusion or a malocclusion, theintercuspation of the teeth as they mesh will bring maxillary tooth cuspinclines (18) and mandibular tooth cusp inclines (17) into closeproximity or touching (whether they have the thin retentive material onthem or not). In a lateral excursion of the mandible, without theappropriate anterior lateral excursion guidance of the AGP (1) ofcurrent application, these inclines (17), (18) would collide potentiallydamaging the teeth, but also these deviating inclines (17), (18)(posterior interferences) could produce both working (W) and non-working(NW) interferences and would give a proprioceptive message to themuscles to deviate over these posterior interferences, thereforestimulating the muscles to hold the mandible in this deviated position,ultimately placing the TMJ into an inappropriate position, leading tomuscle spasticity and possible TMJ or other damage.

If the guidance were flat like some previous systems, the verticaldimension of the entire appliance must be increased dramatically toavoid these interferences. Therefore even when the mandible is at restin centric relation, and not even in an excursion, the verticaldimension of the entire appliance would be so excessive, that for manypatients, it could not be used, or at a minimum would be moreuncomfortable as compared to the AGP splint (4-1). The AGP (1) ofcurrent application solves the vertical dimension problem because itgives appropriate lateral excursion anterior guidance (7) also in avertical way by guiding the smooth protrusion (12) of the mandibularguidance component (1-b) downward (inferiorly) much like ideal toothanterior guidance gives to an ideal occlusion.

The most common use of the AGP (1) will be for the treatment andamelioration of bruxism, however the AGP (1) has the unique ability tocontrol and limit the front end of the mandible three-dimensionallyindependent of malocclusion or condition of the patients' teeth. Thisrevolutionary property offers a wide range of solutions for othermaladies of the mouth, jaws and TMJ. When using the AGP (1), not onlydoes the operator have three-dimensional control of the anterior of themandible, but dependent upon the malady and treatment proscribed, theAGP (1) can be indexed in a position of the operators choosing otherthan centric relation to greatly expand the scope of treatmentsavailable.

Human malocclusions can be complex. In general they can be classifiedClass 1, 2 and 3. These occlusions/malocclusions can be furthercomplicated by anterior and posterior crossbites, overjet, deep bite,open bite and other modifiers and combinations thereof. Andunfortunately human occlusions and mal-occlusions are so diverse to eachindividual that a particular AGP cannot be assigned to a particularocclusion or malocclusion. In regard to bruxism splints, the goal in allthese plethora of different occlusions and malocclusions in the contextof bruxism, is to provide anterior guidance to neutralize posteriorinterferences to allow the mandible to function in the best stressbearing position of centric relation even under the stress of bruxismand to decrease muscle activity and spasticity giving protection to theteeth and the TMJ, reduction of myo-facial pain syndrome and migraineheadache. By using one of the three choices of bruxism AGPs (FIGS. 2,16and 17) in the construction of an AGP bruxism splint would provide asuperior bruxism appliance to 95% of bruxism patients regardless theirmalocclusion.

FIG. 16 is another example and a different design of a bruxism AGP (1),a “canine guidance” AGP (1), for a different version of a bruxismsplint. There are two protrusions (12 a and 12 b) on the mandibularcomponent (1-b) of the AGP (1) that are spaced laterally apart in a waythat would mimic ideal human “canine” anterior guidance. In other words,the mandibular component of the AGP, which mimics ideal lower canines,functions against the maxillary component of the AGP, which mimics idealmaxillary teeth. This design is developed for patients whose particularinterferences (malocclusion) can be more efficiently neutralized byanterior guidance focused upon lateral poles of the mandibular componentof the AGP, as compared to a single pointed protrusion (12) of themandibular component (1 b) of FIG. 11, when a patient wears the splint(1-4) and bruxes. The maxillary component (1-a) of the AGP (1) would bemodified accordingly to provide three-dimensional guidance and limits tothe mandible according to canine guidance when the patient bruxes. Theoverall shape of the maxillary component (1-a) of the AGP (1) isincluding, but not limited to, a smoothly rounded square, smoothlyrounded oval, smoothly rounded pentagonal, smoothly rounded hexagonalshape. The size of the maxillary component (1-a) is less than 50 mm by50 mm dependent upon the full range of motion and border limits of themandible both horizontally and vertically for a particular patient.

In this example there are two areas of centric relation contact (5 a)and (5 b) on the posterior aspect of the flat area of the maxillarycomponent (1-a) with a much broader area of long centric (6) on theanterior aspect of the flat area of the maxillary component (1 a).

When the patient moves his mandible in laterotrusion to the left, onlythe left protrusion (12 b) will be in contact.

As the patient moves his mandible back to centric relation the rightprotrusion (12 a) moves back into contact simultaneous with the leftprotrusion (12 b).

As the patient moves his mandible in laterotrusion to the right fromcentric relation only the right protrusion (12 a) will be in contactwith the maxillary aspect of the AGP (1-a). Within the full range ofmotion of the TMJs (11R and 11L) of the mandible (13), both protrusions(12 a and 12 b) of the mandibular component (1 b) of the AGP (1) will bein contact in centric relation (CR) with the maxillary component (1 a)of the AGP (1) at points (5 a) and (5 b), or long centric area (6) orone or the other protrusions (12 a or 12 b) will be in contact with aninclined plane, lateral guidance (7), which locate on the lateralaspects of the inclined plane, or protrusive guidance (8), which locateson the anterior aspect of the inclined plane, of the maxillary component(1-a) of the AGP (1) to provide appropriate anterior “canine” guidanceto avoid posterior interferences, eliminate engrams, reduce the force ofthe muscles of mastication, and to allow freedom to the condyles (10-Rand 10-L) of the TMJ's (11-R and 11-L) to be in their best stressbearing positions regardless the patient's individual occlusion ormalocclusion.

This is all done with a minimal vertical dimension (VD) penalty,preferably less than 5 mm, when the patient is at rest as compared toall previous systems because the elimination of posterior interferencesis accomplished with true three-dimensional guidance displacing themandible inferiorly in excursions from centric relation. An excursionwould be a movement of the mandible left, right or protrusively from thehinge axis of centric relation. From the hinge axis of centric relation,or another point or axis of the operators choosing, the threedimensional guidance of FIGS. 16 through 20 of the AGP provides anteriorguidance and eliminates the interferences of all excursions to the fullborder limits of the mandible. And furthermore, the guidance of the AGP(1) may be placed anterior to the anterior teeth so the physicalmaterial for that guidance (AGP) is not developed on a splint at aposition in between maxillary and mandibular anterior teeth, but ratherindependent of the position of anterior teeth and could be anterior toanterior teeth. FIG. 16-a is a perspective cross-sectional view of themandible hinging up in centric relation indexing a bruxism AGP for apatient with or without a complex malocclusion onto the retentive pieceswhen the mandible is in centric relation and the vertical dimension isappropriate according to the first contact.

FIG. 16-b is a perspective view of the special retentive piece (20) ofthe current invention for the maxilla, the mandible, or both. Thespecial retentive piece (20) for the maxilla, the mandible, or both hasa shelf (21) to receive the appropriate respective component of the AGP(Anterior Guidance Package). The shelf (21) is located on the mostanterior side of the retentive piece (20) and the open side of thegroove (22) is oriented toward the apical aspect of the teeth when apatient has a special retentive piece (20) adapted to the maxillaryarch, or the mandibular arch or both arches. The special retentive piece(20) of the current application is moldable, retentive, stiff, and thin.The special retentive piece (20) can be used for both the maxillary andmandibular retentive pieces to place the AGP (1) anterior to the frontteeth to comprise a splint (24) that is a combination of the specialretentive pieces (20) and the AGP (1).

One major advantage to be gained by this characteristic of the AGP (1),as shown in FIG. 16-a, is the ability to place the AGP (1), andtherefore the anterior guidance anywhere on the retentive pieces toinclude the shelf (21). The AGP provides all the guidance independent ofteeth so it may be placed anywhere transversely (horizontally) orlaterally. An example of a benefit of this characteristic of the AGP isthe ability to place the AGP further forward (anterior) than where theanterior teeth are located.

This strategy can increase the mechanical advantage of the AGP (1) andtherefore guidance over the muscles of mastication in contrast to anyprevious system.

This guidance can be provided no matter the condition or even presenceof teeth because the AGP only requires the retentive piece stay on thearch as a foundation for the AGP and the guidance may be placed anteriorto the traditional limitations of guidance with the help of the specialretention piece (20) equipped with a height adjustable shelf (21) shownin FIG. 16-b. There is increased advantage over the muscles ofmastication as compared to any previous system.

FIG. 17 is another example and a different design of a bruxism AGP (1),a “group function anterior guidance” AGP (1), which is created for adifferent version of a bruxism splint. There is a very broad protrusion(12) on the mandibular component (1-b) of the AGP (1) that would mimicgroup function from canine to canine, or premolar to premolar (orwhatever the operator chooses) in a way that would mimic ideal humangroup function anterior guidance. This broadness of protrusion (12) canbe accentuated anterior-posteriorly and/or laterally to give freedom tothe mandible or set limits to the mandible according to the treatmentgoals of the operator.

This design is developed for patients whose particular interferences(malocclusion) can be more efficiently neutralized by anterior guidancethat is broad from the left anterior lateral pole to the right anteriorlateral pole of the mandibular component of the AGP, as compared to asingle pointed protrusion (12) of the mandibular component (1 b) of FIG.11, when a patient wears the splint (1-4) and bruxes.

The maxillary component (1-a) of the AGP (1) would be modified accordingto group function guidance when the patient bruxes.

The overall shape of the maxillary component (1-a) of the AGP (1) isincluding, but not limited to, a smoothly rounded square, smoothlyrounded oval, smoothly rounded pentagonal, smoothly rounded hexagonalshape. The size of the maxillary component (1-a) is less than 50 mm by50 mm dependent upon the full range of motion and border limits of themandible both horizontally and vertically for a particular patient.

There will be a broad area of centric relation stop (5), which isbroader, in contrast to a centric relation stop (5) of a maxillarycomponent that is coupled to a single pole protrusion (12), and locateson the posterior aspect of the flat area of the maxillary component, anda broad area of long centric (6), which is broader, in contrast to anarea of long centric (6) in a maxillary component which is coupled to asingle pole protrusion (12), and locates on the anterior aspect of theflat area of the maxillary component. As with any AGP (1) construction,the steepness and depth of the areas of lateral and protrusive guidanceon the maxillary component (1-a) of the AGP (1) can also be controlledto provide anterior stops and guidance to the mandible for whatevertreatment goals the operator has in mind.

As with any AGP (1) construction, the steepness and depth of theprotrusion (12) or protrusions (12 a and 12 b) of the mandibularcomponent (1-b) of the AGP (1) can also be controlled to provideanterior stops and guidance to the mandible for whatever treatment goalsthe operator has in mind. Within the full range of motion of the TMJ's(11-R and 11-L) of the mandible (13) the broad protrusion (12) of themandibular component (1-b) of the AGP (1) will be in contact in centricrelation (5) with the maxillary aspect (1-a) of the AGP (1) or longcentric area (6) or a lateral aspect of the broad protrusion (12) willbe in contact with an inclined plane, lateral guidance (7), which locateon both lateral aspects of the inclined plane, or protrusive guidance(8), which locates on the anterior aspect of the inclined plane of themaxillary component (1 a) of the AGP (1) to provide appropriate anterior“group function” guidance to avoid posterior interferences, eliminateengrams, reduce the force of the muscles of mastication, and to allowfreedom to the condyles (10-R and 10-L) of the TMJs (11-R and 11-L) tobe in their best stress bearing positions.

This is all done with a minimal vertical dimension (VD) penalty,preferably less than 5 mm, when the patient is at rest as compared toall previous systems because the elimination of posterior interferencesis accomplished with true three-dimensional guidance displacing themandible inferiorly in excursions from centric relation. Andfurthermore, the guidance of the AGP (1) may be placed anterior to theteeth so the physical material for that guidance is not in addition, butindependent of and anterior to anterior teeth. This guidance can beprovided no matter the condition or even presence of teeth and becausethe guidance may be placed anterior to the traditional limitations ofguidance, there is increased advantage over the muscles of masticationas compared to any previous system.

FIG. 18 is an example of TMD (Temporo Mandibular Disorder) treatment AGP(1), an “asymmetric TMD treatment” AGP (1) to enable a clinician totreat a mandible that has had damage to one TMJ, or the muscles,ligaments, or tendons of mastication unilaterally, or other clinicalproblems in which the operator needs the ability to control themovements and limits of the front end of the mandible asymmetrically.This is a very different clinical application of the AGP (1). The designof this AGP (1) reflects the operators' prescription to apply verydifferent guidance and limits to each TMJ (11-R and 11-L) independently.

In this example the protrusion (12) is located laterally to the midline.The asymmetrical depth and steepness of both the mandibular aspect (1-b)and the maxillary aspect (1-a) of the AGP (1) can be controlled toprovide anterior stops, limits and guidance for the treatment goals ofthe operator in this case asymmetrically providing very differentparameters to each TMJ (11-R and 11-L). In this circumstance thepatients' mandible (13) upon closing is guided into a position of rest(5′), which is other than centric relation that is proscribed by theoperator for each patient's particular malady or damage. From thisdesignated position of rest (5′) the three-dimensional guidance to longcentric (6) which has a customized shape, which is designed based on thedamage of each patient on the anterior aspect of the flat area of themaxillary component, to provide guidance for this particular damageprofile and then further to lateral guidance (7), which locate on bothlateral aspects of the inclined plane of the maxillary guidancecomponent, and protrusive guidance (8), which locates on the anterioraspect of the inclined plane of the maxillary guidance component,provide an asymmetrical protection and therapy for the particular damageor malady of each patient.

FIG. 19 is another example of a TMD treatment AGP (1), a “bilateralanterior repositioning TMD treatment” (sometimes called a REPO) AGP (1)to enable a clinician to make an anterior repositioning splint to treatbilateral anterior disc displacement of the TMJ's. Again, a verydifferent clinical application of the AGP (1) and a further example ofthe flexibility of treatments the AGP (1) can provide to a clinicianwith its ability to provide three-dimensional control of the front endof the mandible.

In this circumstance, both the mandibular aspect of the AGP (1-b) andthe maxillary aspect of the AGP (1-a) are modified so that as thepatient closes his mandible (13), it is guided forward and vertically tothe designated position of rest (5′) customized to treat the patients'damage in which both the condyles (10-R and 10-L) of the TMJ's (11-R and11-L) recapture both the discs bilaterally.

The maxillary aspect of the AGP (1-a) has customized protrusive guidance(8 a) located on the posterior aspect of the maxillary component, whereotherwise would be the centric relation position (posterior aspect ofthe maxillary component (1-a); position 5), that guides the mandibleprotrusively and vertically to this therapeutic position of rest (5′).The position of rest (5′) is designated based on the damage of eachpatient.

From this designated position of rest (5′) that has recaptured bothdiscs of the TMJ's, the three-dimensional guidance for the mandible tolong centric area (6), on the anterior aspect of the flat area, and thenfurther to lateral guidance (7), which locate on both lateral aspects ofthe inclined plane of the maxillary guidance component, and protrusiveguidance (8), which locate on the anterior aspect of the inclined planeof the maxillary guidance component, provide symmetrical protection andtherapy for the particular damage or malady each patient exhibits,elimination of posterior interferences, elimination of engrams, and thereduction of the forces of the muscles of mastication. This is all donewith a minimal vertical dimension (VD) penalty when the patient is atrest as compared to all previous systems because the anteriorrepositioning of the condyles (10-R and 10-L) and the elimination ofposterior interferences is accomplished with true three-dimensionalguidance displacing the mandible (13) vertically in the therapeuticmovement to reposition the condyles (10-R and 10-L) and the excursionsfrom this designated position (5′). And furthermore, the guidance of theAGP (1) may be placed anterior to the teeth so the physical material forthat guidance is not in addition, but independent of and anterior toanterior teeth.

This guidance can be provided no matter the condition or even presenceof teeth and because the guidance may be placed anterior to thetraditional limitations of guidance where there is increased advantageover the muscles of mastication as compared to any previous system.

A series of AGPs could be designed by the operator to gently “walk back”the condyles to centric relation as the posterior tissues are healed.

FIG. 20 is another example of a TMD treatment AGP (1), a “unilateralanterior repositioning splint” AGP (1) to enable a clinician to create aTMD treatment appliance which can be selective and differential to eachTMJ (11-R and 11-L) or other unilateral maladies of the mandible (13),or supporting structures. Again, this is another example of a verydifferent clinical application, taking advantage of the robustflexibility of the AGP (1).

In this circumstance, the patient has an anteriorly displaced meniscusin the right TMJ (11-R), and the left TMJ (11-L) is normal. Theclinician proscribes an AGP that anteriorly repositions the right TMJ(11-R) to recapture the displaced meniscus, but allows the left TMJ(11-L) to be in centric relation.

On the mandibular aspect of the AGP (1-b) there are two protrusions (12a and 12 b) in which the protrusion on the right (12 a) is taller andsteeper than the protrusion on the left (12 b).

The maxillary aspect (1-a) of the AGP (1) is modified accordingly. Theright area of anterior repositioning (5 a′), that recaptures theanteriorly displaced disc of the right TMJ, is located anteriorly andhas a deeper indentation that is located anteriorly on the right aspectof the flat area of the maxillary component, and has customized anteriorprotrusive guidance (8 a), posterior to the proscribed area of rest (5a′) in contrast to the position of rest (5 b), which locates on the leftposterior aspect of the flat area of the maxillary component, to enablethe operator to anteriorly reposition the right condyle (10-R) whileallowing the left condyle (10-L) to assume centric relation at rest.

In this circumstance, as the patient closes his mandible (13) the rightcondyle (10-R) is guided anteriorly and vertically by the broader andtaller right protrusion (12 a) of the mandibular aspect (1 b) of the AGP(1) into the deeper and broader area (5 a′) of the maxillary aspect (1a) of the AGP (1) to recapture the displaced disc of the right TMJ(11-R).

The left condyle (10-L) of the left TMJ (11-L) is guided into itscentric relation position by the left protrusion (12 b) of themandibular aspect (l b) of the AGP (1) into the centric relationposition (5 b) of the maxillary aspect (1 a) of the AGP (1). (Pleaserefer FIG. 7 and FIG. 20)

From this therapeutically designated position of rest (5 a′ and 5 b),based on the patients' damage profile, that has recaptured the rightdisc of the right TMJ (11-R), the three-dimensional guidance to longcentric rest (6) and then further to lateral guidance (7), andprotrusive guidance (8), provide asymmetrical protection and therapy forthe particular damage or malady this patient exhibits, elimination ofposterior interferences, elimination of engrams, and the reduction ofthe forces of the muscles of mastication.

This is all done with a minimal vertical dimension (VD) penalty when thepatient is at rest as compared to all previous systems because theanterior repositioning of the right condyle (10-R) and the eliminationof posterior interferences is accomplished with true three-dimensionalguidance displacing the mandible (13) vertically in the therapeuticmovement to reposition the right condyle (10-R) and the excursions fromthis designated therapeutic position. And furthermore, the guidance ofthe AGP (1) may be placed anterior to the teeth so the physical materialfor that guidance is not in addition, but independent of and anterior toanterior teeth. This guidance can be provided no matter the condition oreven presence of teeth and because the guidance may be placed anteriorto the traditional limitations of guidance there can be increasedadvantage over the muscles of mastication as compared to any previoussystem.

The AGP (1) of the current application enables an operator to controlthe patients mandible upon closing to arrive at whatever destination theoperator chooses using whatever route the operator chooses. Theseexamples of the AGP (1) illustrate the robust flexibility of the AGP (1)to enable an operator to create treatment strategies for a wide range ofmaladies or combinations of maladies in which three-dimensional controlcan be applied to the anterior of the mandible in ways never imaginedbefore. The pre-fabricated AGP (1) of the current invention can be madein many different shapes and sizes based on the diagnosis, malocclusion,and treatment plan of the patient. Different styles of bruxism AGP's (1)can be created by changing the shape of the mandibular aspect of the AGP(1-b) from a single protrusion (12), to a broader wider protrusion (12)for a “group function” AGP (1), to two protrusions (12 a and 12 b) for a“canine guidance” AGP (1). The properties of guidance and limits of themaxillary aspect (1-a) of the AGP (1) are appropriately developedopposing these different shapes and sizes of mandibular aspects (1-b) toaccomplish the treatment goals and style of bruxism appliance theoperator proscribes. In the case of damage to the mouth, jaw, TMJdysfunction, or internal derangement, an AGP (1) can be specificallydesigned to address these conditions or combinations of conditions usingthe AGP's (1) unique ability to provide three-dimensional control andlimits for the front end of the mandible. For example, one couldconstruct an AGP (1) with asymmetrical lateral guidance (7) and/orprotrusive guidance (8). An AGP (1) of current invention could beconstructed to anteriorly reposition the condyle of the TMJ bilaterallyor unilaterally. The AGP (1) of current invention enables an operator tocontrol the patients mandible when the patient closes to arrive atwhatever destination the operator chooses using whatever route theoperator chooses. This property of the AGP (1) is unique and enablesmyriad treatment strategies for a wide range of problems or combinationsof problems. The AGP (1) can be indexed into an appliance coincidentwith centric relation position of a patients jaw or at some otherposition of the operators choosing dependent on the treatment goals forthat patient. With the use of the CAD-CAM AGP, which was disclosed inanother application by the inventor, a CAD-CAM AGP could be customproduced by an operator in an unprecedented way providing solutions tothese conditions or combinations of conditions and at a significantlesser expense to both operator and patient.

The AGP (1) of the current application can be specifically produced thatcan move the mandible from the centric relation position into typicalideal guidance patterns for the treatment of bruxism or from a positionother than centric relation into non-traditional guidance pathways forthe treatment of specific TMJ treatment and other maladies. The AGP (1)of the current application can be utilized with alternative ways ofdetermining what position other than centric relation position that themandible should rest and be guided.

What is claimed is:
 1. A pre-fabricated anterior guidance package (AGP),a devise that provides three dimensional guidance, limits, and controlto the mandible, for patients with complex occlusions and bruxismcomprises of; a mandibular guidance component that has two protrusionsof (12 a) and (12 b), which are spaced laterally apart in a way thatmimic ideal lower canines, functioning against maxillary canines, and amaxillary guidance component which has; two areas of centric relationcontacts of (5 a) and (5 b), on the posterior aspect of a flat area ofthe maxillary component, that receive two protrusions of (12 a) and (12b), respectively, and has; a broad long centric area (6) on the anterioraspect of the flat area of the maxillary component, and has; pluralitiesof lateral guidance (7) on both lateral aspects of an inclined plane ofthe maxillary guidance component, and has; pluralities of protrusiveguidance (8) on the anterior aspect of the inclined plane of themaxillary guidance component to provide three-dimensional guidance andlimits to the mandible that mimics canine guidance when the patientbruxes.
 2. A pre-fabricated anterior guidance package (AGP), a devisethat provides three dimensional guidance, limits, and control to themandible, for patients with bruxism comprises of; a mandibular guidancecomponent that has two protrusions of (12 a) and (12 b), which arespaced laterally apart in a way that mimic ideal lower canines,functioning against maxillary canines, and a maxillary guidancecomponent which has; two areas of centric relation contacts of (5 a) and(5 b), on the posterior aspect of a flat area of the maxillarycomponent, that receive the two protrusions of (12 a) and (12 b),respectively, and has; a broad long centric area (6) on the anterioraspect of the flat area of the maxillary component, and has; pluralitiesof lateral guidance (7) on both lateral aspects of an inclined plane ofthe maxillary guidance component, and has; pluralities of protrusiveguidance (8) on the anterior aspect of the inclined plane of themaxillary guidance component to provide three-dimensional guidance andlimits to the mandible that mimics maxillary canines according to canineguidance when the patient bruxes.
 3. A pre-fabricated anterior guidancepackage (AGP), a devise that provides three dimensional guidance,limits, and control to the mandible, for patients with complexocclusions and bruxism comprises of; a mandibular guidance componentthat has a very broad protrusion that mimics group function frompremolar to premolar in a way that mimics ideal human group functionanterior guidance, and a maxillary guidance component which has; a broadarea of centric relation stop (5) on the posterior aspect of a flat areaof the maxillary component, and has; a broad area of long centric (6) onthe anterior aspect of the flat area of the maxillary component, andhas; pluralities of lateral guidance (7) on both lateral aspects of aninclined plane of the maxillary guidance component, and has; pluralitiesof protrusive guidance (8) on the anterior aspect of the inclined planeof the maxillary guidance component to provide three-dimensionalguidance and limits to the mandible that mimics group function guidancewhen the patient bruxes.
 4. A pre-fabricated anterior guidance package(AGP), a devise that provides three dimensional guidance, limits, andcontrol to the mandible, for patients with bruxism comprises of; amandibular guidance component that has a very broad protrusion thatmimics group function from premolar to premolar in a way that mimicsideal human group function anterior guidance, and a maxillary guidancecomponent which has; a broad area of centric relation stop (5) on theposterior aspect of a flat area of the maxillary component, and has; abroad area of long centric (6) on the anterior aspect of the flat areaof the maxillary component, and has; pluralities of lateral guidance (7)on both lateral aspects of an inclined plane of the maxillary guidancecomponent, and has; pluralities of protrusive guidance (8) on theanterior aspect of the inclined plane of the maxillary guidancecomponent to provide three-dimensional guidance and limits to themandible that mimics group function guidance when the patient bruxes. 5.A pre-fabricated anterior guidance package (AGP), a devise that providesthree dimensional guidance, limits, and control to the mandible, forpatients with complex occlusions, temporo-mandibular-dysfunction (TMD)and bruxism comprises of; a mandibular guidance component that has aprotrusion located laterally to the midline, and a maxillary guidancecomponent that has a designated position of rest (5′) that isasymmetrically located on the posterior aspect of a flat area of themaxillary component based on the damage of each patient, and has; a longcentric (6) of customized shape, which is designed based on the damageof each patient, on the anterior aspect of the flat area of themaxillary component, and has; pluralities of lateral guidance (7) onboth lateral aspects of an inclined plane of the maxillary guidancecomponent, and has; pluralities of protrusive guidance (8) on theanterior aspect of the inclined plane of the maxillary guidancecomponent to provide asymmetrical guidance for protection and therapyfor a particular damage and malady.
 6. A pre-fabricated anteriorguidance package (AGP), a devise that provides three dimensionalguidance, limits, and control to the mandible, for patients with complexocclusions, temporo-mandibular-disorder (TMD) comprises of; a mandibularguidance component wherein a protrusion is located laterally to themidline, and a maxillary guidance component has a designated position ofrest (5′) that is asymmetrically located on the posterior aspect of aflat area of the maxillary component, based on the damage of eachpatient, and has; a long centric (6) of customized shape, which isdesigned based on the damage of each patient, on the anterior aspect ofthe flat area of the maxillary component, and has; pluralities oflateral guidance (7) on both lateral aspects of an inclined plane of themaxillary guidance component, and has; pluralities of protrusiveguidance (8) on the anterior aspect of the inclined plane of themaxillary guidance component to provide asymmetrical guidance forprotection and therapy for a particular damage and malady.
 7. Apre-fabricated anterior guidance package (AGP), a devise that providesthree dimensional guidance, limits, and control to the mandible, totreat bilateral anterior disc displacement of a pair oftemporo-mandibular-joints (TMJs) comprises of; a mandibular guidancecomponent which has a broad protrusion, and a maxillary guidancecomponent which has a designated position of rest (5′) on the posterioraspect of a flat area of the maxillary component, based on the damage ofeach patient, and has; a long centric (6) area on the anterior aspect ofthe flat area of the maxillary component, and has; pluralities oflateral guidance (7) on both lateral aspects of an inclined plane of themaxillary guidance component, and has; pluralities of protrusiveguidance (8) on the anterior aspect of the inclined plane of themaxillary guidance component, and has; pluralities of customizedprotrusive guidance (8 a) located on the posterior aspect of themaxillary component to guide the mandible protrusively and vertically.8. A pre-fabricated anterior guidance package (AGP), a devise thatprovides three dimensional guidance, limits, and control to themandible, to treat a patient who has an anteriorly displaced meniscus inone, right-, TMJ but the other, left-, TMJ is normal comprises of; amandibular guidance component which has two protrusion of rightprotrusion (12 a) and left protrusion (12 b), among which the rightprotrusion (12 a) is taller and steeper than the left protrusion (12 b),and a maxillary guidance component which has; a right area of anteriorrepositioning (5 a′) that is located anteriorly and has a deeperindentation on the right aspect of a flat area of the maxillarycomponent, and has; a position of rest (5 b) on the left posterioraspect of the flat area of the maxillary component to enable an operatorto anteriorly reposition the right condyle while allowing the leftcondyle to assume centric relation at rest, and has; pluralities ofcustomized anterior protrusive guidance (8 a) posterior to the area ofrest (5′), and has; a long centric (6) of customized shape, which isdesigned based on the damage of each patient, on the anterior leftaspect of a flat area of the maxillary component, and has; pluralitiesof lateral guidance (7) on both lateral aspects of an inclined plane ofthe maxillary guidance component, and has; pluralities of protrusiveguidance (8) on the inclined plane of the maxillary guidance componentto guide the mandible protrusively and vertically.